Journal of neurology, neurosurgery, and psychiatry
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Twenty six patients who had received spinal cord stimulation for chronic pain were evaluated by videotaped structured interviews with staff not directly involved in the patients' care. In addition estimates of pain relief were obtained from clinicians involved in the patients' care and from close relatives and friends. Information about lifestyles and drug usage was also collected and correlated with pain relief. At the time of the interviews half of the patients were receiving 50% or better relief of their pain.
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J. Neurol. Neurosurg. Psychiatr. · Sep 1987
Clinical Trial Controlled Clinical TrialThermal sensitivity is not changed by acute pain or afferent stimulation.
The effect of conditioning stimulation on thermal sensitivity and clinical pain was studied in 40 patients and six healthy subjects. Thresholds regarding cold, warm and heat pain perception did not differ significantly between the painful and non-painful skin areas in patients or between patients and healthy subjects before stimulation. ⋯ No significant changes in thermal sensitivity were observed during and after conditioning stimulation in any of the test groups, although 24/40 (60%) of the patients reported reduction of their clinical pain intensity. The results indicate that (a) thermal sensitivity is not influenced by the presence of clinical pain, (b) the effects of stimulation on thermal sensitivity (thresholds) and clinical pain are not closely related, (c) central inhibitory effects of TENS and vibration are crucial for their pain relieving capacity.
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J. Neurol. Neurosurg. Psychiatr. · Aug 1987
Case ReportsCraniopharyngioma in the third ventricle: necropsy findings and histogenesis.
A case of craniopharyngioma confined within the third ventricle with necropsy is reported. A stalk-like structure in this tumour was present in the wall of the third ventricle at its base. It is suggested that this tumour might have arisen from the remnants of Rathke's pouch persisting in the tuber cinereum.
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J. Neurol. Neurosurg. Psychiatr. · Aug 1987
Case ReportsNeck tumour with syncope due to paroxysmal sympathetic withdrawal.
A patient with recurrent squamous carcinoma metastatic to the neck after radical neck dissection and high dose radiation therapy developed paroxysmal hypotensive episodes that were severe, spontaneous and characterised by suppressed sympathetic but not enhanced parasympathetic activity. Intravenous pressors were successful in treating acute episodes but neither drug therapy nor surgical neck exploration reliably prevented syncopal attacks. Glossopharyngeal and/or vagal nerve infiltration by tumour with episodic activation of the afferent limb of the baroreflex arc producing vasodilatation primarily due to sympathetic withdrawal is the likely mechanism of life threatening syncope in this patient.
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A significant rank correlation between rigidity and putaminal signal dropout on magnetic resonance imaging (MRI) in patients with multiple system atrophy suggests that putaminal degeneration may cause this clinical finding. Absence of putaminal abnormalities on MRI in patients with pure autonomic failure may prove useful in differentiating these two autonomic disorders.